Healthy Cities -
Healthy Communities

by Joe Flower

You know what a healthy community is. Somewhere, you've experienced it - a community that nurtures its members, that makes us all more than we were. But what makes a community healthy? What builds health, it turns out, also builds community, safety, wealth, and families. The health of a community grows from how many children people have, in what kind of families, with how much money and education, from a sense of choice, and from friends and family who give life meaning, from clean water and air, and basic medicine, from families who eat well, are well housed, secure from crime, and not deranged by drugs or alcohol. Building a healthy community requires all the energy the community can muster, from everyone who can make a difference - but it can be done. There are ways to do it. This powerful idea has taken hold in over a thousand cities and towns around the world. This is how to build a world that works.

You want to build a world that works? Try this.

I am speaking seriously. The world is full of well-meaning, hard-working people - and the world is spinning into chaos, into famine, war, crime, and plagues. Perhaps you would like to help change that. Perhaps you would like to make a difference, but there doesn't seem to be any way that works. Here is a way that works. It starts where you live.

You know what a healthy community is. Somewhere in your life, you've experienced it - a community that nurtures its members, that gives us all more, makes us all larger than we were. But what makes a community healthy?

We and others have asked that question in hundreds of gatherings in cities and communities around the world: what would make this a healthier place? The answers that come back are surprising and powerful, different for every city and community. They have to do with everything from transportation, jobs, and housing to sex - and they are profoundly accurate.

People live longer and healthier lives if they eat well, are well housed, are secure from war, crime, and domestic violence, are not deranged by drugs or alcohol, if they have plenty of clean water for drinking and washing, if they breathe clean air, if they have access to basic vaccines and antibiotics, if they can exercise some sense of choice in their lives, and if they have friends and family to give life meaning. The health of a community depends upon how many children people have, at what age and in what kind of families, what dynamics exist inside their homes, how much money and education they have, with whom they have sex and how, and what they do with their sewage.

Medicine and public health are rarely at the top of the list. Skilled medical professionals, the right drugs and the right machines all help, but they are not enough.

What builds health, it turns out, also builds community, public safety, wealth, and families. These are systemic tasks that require all the energy and creative thought a community can muster, from everyone who can make a difference, from business, the media and government to the poor and unrepresented.

In the mid-1980s, inspired by the writings of Len Duhl (interview), Trevor Hancock set out to organize "Healthy Toronto 2000." That effort inspired Ilona Kickbush at the World Health Organization's European office, which catalyzed full-scale, formal efforts in 34 European cities over the next few years. This in turn inspired the World Health Organization's global office, and other organizations, such as the Healthcare Forum, the Western Consortium for Public Health, and the National Civic League in the United States, to spread the idea. In seminars and workshops around the world, Dr. Duhl and Dr. Hancock have helped scores of cities take the first steps toward envisioning and creating their futures. Hundreds of cities and communities have held the WHO's "vision workshops" to learn how to begin the process. The WHO's formal efforts count 18 national networks in Europe, North America, and Australia, state efforts in the U.S. such as California Healthy Cities and Indiana Healthy Cities, several regional and language-specific networks, and a host of independent initiatives, including many spread across the developing world. The first International Healthy Cities and Communities Conference, held last December in San Francisco, attracted over 1400 delegates from 50 countries and 40 U.S. states.

The movement's organizing method is rather simple: people in Barcelona (or Calcutta, or Sacramento) invite in some outsiders to help them. In one conference or a series of them, the local committee and the outside facilitators gather together everyone in the community who can make a difference - media, politicians, labor union bosses, educational leaders, representatives of the unrepresented, business leaders, community organizers - and ask them, "What would make this a healthier place?" The answer may center around jobs or housing, or the environment, or crime, clean drinking water, better food, even transportation. The consensus is often surprisingly strong.

Having found common ground in things that everyone agrees must change, the organizers then set about to help the people in the room discover what they can do, working together, to change it. The results are amazing, unpredictable, heartening, and sometimes earth-shaking. They include, in some places, things you might expect: immunization drives, HIV education, or building a clinic. In other places, things pop up that you would never have put on a list. In Horsens, Denmark, the local women put together a sewing circle with the Turkish women in town, so that they might learn each other's language, so that they could draw them into the community, so that they could help the children. In Cali, Colombia, a cooperative sprang up to provide cheap building materials. In Honduras, a dirt-poor neighborhood of refugees camped on a barren hillside organized to bring in fresh clean water, then for a "honey wagon" to carry off human waste, and finally for a real sewer system. In a remote Indian village in New Mexico, building a healthy community meant both a re-awakening of the ancient Indian ways, and a karate class for the youngsters, to teach them discipline and self-esteem.

Is this easy and neat? No, it is both difficult and messy. It's not a Sunday picnic in the park. It's long, political, and human, full of talk, with lots of walking the streets, lots of meetings, lots of gathering information, lots of listening. It's hard because it strikes directly to the heart of what it takes to live together in cities and communities at the end of the 20th Century. It's hard, but there does not seem to be any easy way that works, any other way than straight through the middle - let's get down and talk about it: what does it take? What do we have to do? What are the tools? Who is ready to help?

The stories are endless, and they make a real difference in a way that cuts through the usual political struggles. The idea, and the set of simple organizing tools that go with it, have proven fruitful and flexible for people around the world to use in improving their own lives. It's a practical, functional idea that connects global thinking directly with local action and local government, that pulls in the energies of business leaders, educational and planning professionals, and the neighborhoods, that brings people together rather than dividing them into special interest groups, and that connects one community to another, in a global network of communities learning from each other.

The idea works because it attracts the enormous personal energy and resources of the community. The people of the community "own" every part of it. It reflects their values. It focuses on their lives. It gives them power and permission to make a difference in their lives. It gives them a lever and a place to stand.